Self-Screening Checklist | Spring 2021
The safety and well-being of our students and staff continue to be our highest priority. This self-screening daily checklist is part of our COVID-19 safety guidelines. Please answer each daily health question with a "Yes" or "No". In accordance with our guidelines, once you have completed and submitted this form you will receive an email with the screening results that must be presented to the athletic trainer or staff member at check-in.
The Self-Screen Participation Email will be sent to the address entered below. If you have any questions, please contact Mr. King, Athletic Director.
Email Address *
Enter the email address where you want to receive the Self-Screening Participation Email.
Name *
Please the FIRST AND LAST NAME
Spring Sport Session *
Self-Check *
Please review the list of symptoms checking "Yes" if you have this symptom and "No" if you do not have the symptom and answer all other questions.
Yes
No
Fever or Chills
Nasal Congestion or Runny Nose
Sore Throat
Shortness of Breath or Difficulty Breathing
Diarrhea
Nausea or Vomiting
Fatigue
Headache
Muscle or Body Aches
New Loss of Taste or Smell
Fever (if higher than 100.3)
How you been in close contact with any person who has recently been tested positive for COVID-19?
Are you out of compliance with the travel-related guidance found at: https://portal.ct.gov/Coronavirus/Travel?
Submit
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